us trends in refractive surgery:2002 isrs survey richard j. duffey, md david leaming, md isrs...
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US TRENDS IN REFRACTIVE SURGERY:2002 ISRS SURVEYUS TRENDS IN REFRACTIVE SURGERY:2002 ISRS SURVEY
Richard J. Duffey, MDRichard J. Duffey, MD
David Leaming, MDDavid Leaming, MD
ISRS MeetingISRS Meeting
Orlando- October 18, 2002Orlando- October 18, 2002
DUFFEY 2002
2002 SURVEY2002 SURVEY Aug. mailing to 900 U.S. members of ISRSAug. mailing to 900 U.S. members of ISRS 107 responses analyzed by Sept 28 for 12% of the 107 responses analyzed by Sept 28 for 12% of the
U.S. ISRS membership*U.S. ISRS membership* Sixth year of refractive data collection allowing Sixth year of refractive data collection allowing
an analysis of trends in USan analysis of trends in US RK, AK/LRI, PRK, LASIK, LASEK, ICR, LTK, RK, AK/LRI, PRK, LASIK, LASEK, ICR, LTK,
CK, CLE, P-IOL, SE, excimer lasers, CK, CLE, P-IOL, SE, excimer lasers, microkeratomes, topograp., comanagement, microkeratomes, topograp., comanagement, followup exams, pupillometry, custom abl.followup exams, pupillometry, custom abl.
DUFFEY 2002
> 5 CASES / MONTH> 5 CASES / MONTH
20
2 0
26
27
39
85
0
24
7 6 3 1 0 05
0102030405060708090
RK
PR
K
LA
SIK
ICR
AK
-IO
L
AK
LA
SEK
CL
E
P-I
OL SE
LT
K
CK
'97'98'99'00'01'02
DUFFEY 2002
> 25 CASES / MONTH> 25 CASES / MONTH
60
15
54
0 0 03 3
00
10
20
30
40
50
60P
RK
LA
SIK
ICR
LT
K
P-I
OL
LR
I/IO
L
LR
I
LA
SEK
'97'98'99'00'01'02
DUFFEY 2002
> 75 CASES / MONTH> 75 CASES / MONTH
0 0 0 0 0 0 0 0 0 0 0 0
5
13
1614
27
21
0
5
10
15
20
25
30
RK PRK LASIK
'97'98'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 30 yo -3.00 DIOPTER MYOPEPREFERRED SURGERY FOR 30 yo -3.00 DIOPTER MYOPE
13
1 1
41
3 1
46
97
4 1 0 0 0 0 1 400
10
20
30
40
5060
70
80
90
100
RK PRK LASIK ICR CLE P-IOL WAIT
'97'98'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 30 yo -7.00 DIOPTER MYOPEPREFERRED SURGERY FOR 30 yo -7.00 DIOPTER MYOPE
16
0
76
96
0 2 500
1020
3040
5060
7080
90100
PRK LASIK CLE P-IOL WAIT
'97'98'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 30 yo -12.00 DIOPTER MYOPEPREFERRED SURGERY FOR 30 yo -12.00 DIOPTER MYOPE
0 2
76
36
5
2215
31
40
10
20
30
40
50
60
70
80
PRK LASIK CLE P-IOL WAIT LASEK
'97'98'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 45 yo +1.00 D HYPEROPEPREFERRED SURGERY FOR 45 yo +1.00 D HYPEROPE
2 2
70
80
4 3 0 3
24
3 28
0
10
20
30
40
50
60
70
80P
RK
LA
SIK
LT
K
CL
E
WA
IT
LA
SEK
CK
'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 45 yo +3.00 D HYPEROPEPREFERRED SURGERY FOR 45 yo +3.00 D HYPEROPE
1 1
8693
0 0 2 313
1 2 0 00102030405060708090
100P
RK
LA
SIK
LT
K
CL
E
WA
IT
LA
SEK
P-I
OL
CK
'99'00'01'02
DUFFEY 2002
PREFERRED SURGERY FOR 45 yo +5.00 D HYPEROPEPREFERRED SURGERY FOR 45 yo +5.00 D HYPEROPE
0 0
32 33
20
33
49
33
20
10
20
30
40
50
60
PRK LASIK CLE WAIT LASEK
'99'00'01'02
DUFFEY 2002
SURGERY DONE BILATERAL AT SAME O.R. VISIT SURGERY DONE BILATERAL AT SAME O.R. VISIT
30
6164
99
86
66
28
0 00102030405060708090
100P
RK
LA
SIK
LA
SEK
CK SE
CL
E
P-I
OL
'97'98'99'00'01'02
DUFFEY 2002
Procedure Future Index (Doing Now and/or Plan in Future)Procedure Future Index (Doing Now and/or Plan in Future)
9098
8288
798376
93
67
19
45
1422
11
6958
37
0102030405060708090
100L
ASI
K
CL
E
P-I
OL
PR
K
LT
K
ICR
RK
LA
SEK
CK SE
'00'01'02
DUFFEY 2002
Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia
49
37
11
1 0 05
05
101520253035404550
Mon
oLA
SIK
MM
LA
SIK
Mul
tifo
calI
OL
SE
IR30
00
AC
S
Oth
er
'02
DUFFEY 2002
HAD REFRACTIVE SURGERY PERFORMED ON YOURSELFHAD REFRACTIVE SURGERY PERFORMED ON YOURSELF
56
8
18
0 0 0 0 00
2
4
6
8
10
12
14
16
18
PRK LASIK ICR LTK CLE P-IOL CK
'98'99'00'01'02
DUFFEY 2002
TOPOGRAPHY UNIT MOST COMMONLY USED TOPOGRAPHY UNIT MOST COMMONLY USED
39
13
34
18
32
1
24
9 10
17
30
5
10
15
20
25
30
35
40
EyeSys Tomey Zeiss-Hum
Orbscan Alcon Others
'98'99'00'01'02
DUFFEY 2002
EXCIMER LASER MOST COMMONLY USEDEXCIMER LASER MOST COMMONLY USED
50
61
32
0
12
0
24
0 3
13
00
10
20
30
40
50
60
70
80
90
VisX Summit Nidek Auton B and L Others
'97'98'99'00'01'02
DUFFEY 2002
MICROKERATOME MOST COMMONLY USEDMICROKERATOME MOST COMMONLY USED
18
55
125
10
04 1 0
5 3 50
10
20
30
40
50
60B
-L H
ansa
Mor
ia L
SK
Mor
ia C
-B
Inno
vat
Nid
ek
SKB
M
Fla
pM
Mor
ia D
isp
Am
adeu
s
Mor
ia M
2
'98'99'00'01'02
DUFFEY 2002
Value of Custom AblationValue of Custom Ablation
10
48
1922
205
10
1520
2530
3540
4550
Extreme Moderate Neutral Little None
'02
DUFFEY 2002
Wavefront AnalyzerWavefront Analyzer
77
12
2 3 3 20
10
20
30
40
50
60
70
80
NO VisX Alcon B and L Tracey Other
'02
DUFFEY 2002
Pupil Guage Instrument UsePupil Guage Instrument Use
47
33
14
6
05
101520253035404550
Colvard Card Procyon Other
'02
DUFFEY 2002
LASIK Post-Op AntibioticLASIK Post-Op Antibiotic
50
21 19
10
05
101520253035404550
Ocuflox Quixin Ciloxan Tobramycin
'02
DUFFEY 2002
Asymptomatic High MyopePre-op Retinal Referral: Y/NAsymptomatic High MyopePre-op Retinal Referral: Y/N
15
85
0
10
20
30
40
50
60
70
80
90
Yes No
'02
DUFFEY 2002
ComanagementComanagement
2520
7580
37
46
2126
13 16
0
10
20
30
40
50
60
70
80
No >1% >25% >50% >75%
'00'01
DUFFEY 2002
Comanage with WhomComanage with Whom
34 33
54
35
66
56
7773
0
10
20
30
40
50
60
70
80
MD-in MD-out OD- in OD-out
'00'01
DUFFEY 2002
’02 ISRS SURVEY CONCLUSIONS’02 ISRS SURVEY CONCLUSIONS
LASIK dominates between -12D and +3DLASIK dominates between -12D and +3D Bilateral same O.R. visit LASIK Bilateral same O.R. visit LASIK LASIK, LASEK, CLE, P-IOL, PRK, CK all LASIK, LASEK, CLE, P-IOL, PRK, CK all
with apparent bright futures with apparent bright futures RK, ICR, LTK dead or dyingRK, ICR, LTK dead or dying VisX at 2:1 over all other lasersVisX at 2:1 over all other lasers Wavefront, custom ablations still in futureWavefront, custom ablations still in future Pupillometry 2:1 Instrument versus CardPupillometry 2:1 Instrument versus Card
Thanks to the ISRS leadership for their support and for your
participation in the 2002 Survey
Thanks to the ISRS leadership for their support and for your
participation in the 2002 Survey
We look forward to your response to We look forward to your response to the 2003 survey next fallthe 2003 survey next fall
Results at www.isrs.orgResults at www.isrs.org